Metoclopramide (1a), possessing a dopamine D 2 receptor antagonist and weak serotonin 5-HT 4 receptor agonist activities, 1a) is used clinically as a gastrointestinal prokinetic and an antiemetic agent. 1b) However, its clinical application is limited due to its side effects, such as extrapyramidal syndrome, parkinsonism and elevated serum prolactin levels, caused by blockage of the dopamine D 2 receptor.We previously reported that the introduction of a methylenephenoxy group between the benzamide moiety and the terminal aminoalkyl groups of 1a led to the discovery of itopride (2), with an appropriate dopamine D 2 receptor antagonist activity and a distinctive acetylcholine esterase inhibitory activity.2) On the other hand, we suggested that amphoteric-ionization would be a useful approach to discovering a new drug, and actually succeeded in finding selective histamine H 1 antagonists by applying this method to classical antihistaminics.3) We initially applied the amphoteric-ionization to 1a in order to find a new type of gastrointestinal prokinetic agent. Although we preliminarily synthesized an amphoteric-ionized compound (3) by the introduction of an alkanecarboxylic acid moiety onto the terminal nitrogen atom of 1a, it had no significant gastrointestinal prokinetic activity. Cisapride (1b), 4) which has a conformationally restricted amino moiety in comparison with 1a, has been found to show more potent gastrointestinal prokinetic activity than 1a. We therefore expected that some kind of conformational restriction of 3 would lead to an increased gastrointestinal prokinetic activity, and designed a series of [[(4-amino-5-chloro-2-methoxybenzoyl)amino]cycloamino]alkanecarboxylic acid derivatives (4).In this paper, we describe the synthesis and gastrointestinal prokinetic activity of a series of [[(4-amino-5-chloro-2-methoxybenzoyl)amino]cycloamino]alkanecarboxylic acids (4). We also discuss conformational effects on gastrointestinal prokinetic activity and the evaluation of ester prodrugs of 4-[(4-amino-5-chloro-2-methoxybenzoyl)amino]-1-piperidineacetic acid (19), which exhibited the most excellent gastrointestinal prokinetic activity.Chemistry New amphoteric compounds (19-24, 32a-c, 38, 43d-f) and prodrugs (44-60) of compound 19 were synthesized as shown in Charts 2-6.As shown in Chart 2, benzamides (19-24) with 1- 19-24, 32a-c, 43d-f